Health care costs associated with hepatocellular carcinoma: A population-based study

Authors

  • Hla-Hla Thein,

    Corresponding author
    1. Ontario Institute for Cancer Research/Cancer Care Ontario, Toronto, Ontario, Canada
    • Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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  • Wanrudee Isaranuwatchai,

    1. Health Economics Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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  • Michael A. Campitelli,

    1. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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  • Jordan J. Feld,

    1. Liver Centre, Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ontario, Canada
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  • Eric Yoshida,

    1. University of British Columbia, Division of Gastroenterology, Vancouver, British Columbia, Canada
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  • Morris Sherman,

    1. University Health Network, University of Toronto, Gastroenterology, Toronto, Ontario, Canada
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  • Jeffrey S. Hoch,

    1. Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
    2. Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada
    3. Canadian Centre for Applied Research in Cancer Control (ARCC), University of British Columbia, Vancouver, BC, Canada
    4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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  • Stuart Peacock,

    1. Canadian Centre for Applied Research in Cancer Control (ARCC), University of British Columbia, Vancouver, BC, Canada
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  • Murray D. Krahn,

    1. Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, Ontario, Canada
    2. Departments of Medicine and Health Policy, Management and Evaluation and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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  • Craig C. Earle

    1. Ontario Institute for Cancer Research/Cancer Care Ontario, Toronto, Ontario, Canada
    2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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  • See Editorial on Page 1213

  • Potential conflict of interest: Nothing to report.

  • Supported through provision of data by the Institute for Clinical Evaluative Sciences (ICES) and Cancer Care Ontario (CCO) and through funding support to the ICES from an annual grant by the Ministry of Health and Long-Term Care and the Ontario Institute for Cancer Research (OICR). The opinions, results, and conclusions reported in this paper are those of the authors. No endorsement by ICES, CCO, OICR or the Government of Ontario is intended or should be inferred. Hla-Hla Thein is supported by the Ontario Institute for Cancer Research Health Services Research Program New Investigator Award at the Dalla Lana School of Public Health, University of Toronto. Murray Krahn is supported by the F. Norman Hughes Chair in Pharmacoeconomics at the Faculty of Pharmacy, University of Toronto, and in part by the Toronto Health Economics and Technology Assessment Collaborative through the Ontario Ministry of Health and Long-Term Care.

  • This work was presented in part at the Canadian Cancer Research Conference, November 2011, Toronto, Canada (poster presentation); the Canadian Symposium on Hepatitis C Virus, February 2012, Montreal, Canada (oral presentation); the Ontario Institute for Cancer Research and Cancer Care Ontario, Health Services Research Program 4th Annual Meeting, May 2012, Toronto, Canada (poster presentation); and the 2012 Canadian Association for Health Services and Policy Research conference, Montreal, Canada (oral presentation). It was also accepted for a poster presentation at the American Association for the Study of Liver Diseases in November 2012.

Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 560, Toronto, Ontario M5T 3M7, Canada. E-mail: rosie.thein@utoronto.ca fax: 416-978-7735

Abstract

Although the burden of hepatocellular carcinoma (HCC) is an escalating public health problem, it has not been rigorously estimated within a Canadian context. We conducted a population-based study using Ontario Cancer Registry linked administrative data. The mean net costs of care due to HCC were estimated using a phase of care approach and generalized estimating equations. Using an incidence approach, the mean net costs of care were applied to survival probabilities of HCC patients to estimate 5-year net costs of care and extrapolated to the Canadian population of newly diagnosed HCC patients in 2009. During 2002-2008, 2,341 HCC cases were identified in Ontario. The mean (95% confidence interval [CI]) net costs of HCC care per 30 patient-days (2010 US dollars) were $3,204 ($2,863-$3,545) in the initial phase, $2,055 ($1,734-$2,375) in the continuing care phase, and $7,776 ($5,889-$9,663) in the terminal phase. The mean (95% CI) 5-year net cost of care was $77,509 ($60,410-$94,607) and the 5-year aggregate net cost of care was $106 million ($83-$130 million) (undiscounted). The net costs of patients receiving liver transplantation only and those undergoing surgical resection only were highest in the terminal phase. The net cost of patients receiving radiofrequency ablation as the only treatment was relatively low in the initial phase, and there were no significant differences in the continuing and terminal phases. Conclusion: Our findings suggest that costs attributable to HCC are significant in Canada and expected to increase. Our findings of phase-specific cost estimates by resource categories and type of treatment provide information for future cost-effectiveness analysis of potential innovative interventions, resource allocation, and health care budgeting, and public health policy to improve the health of the population. (Hepatology 2013;58:1375–1384)

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